ABS TRACT Objective: Gestational diabetes mellitus (GDM), gestational hypertension (GHT), and preeclampsia are common pregnancy complications associated with adverse maternal and fetal outcomes. This study investigated whether the Antenatal Body Shape Index (ABSI), calculated from early pregnancy anthropometric measurements, is associated with the subsequent development of these complications. Material and Methods: In this prospective cohort study, 170 pregnant women between 6 and 16 weeks of gestation were enrolled. Body mass index (BMI) and ABSI were calculated using measurements obtained at the first antenatal visit. Participants were followed throughout pregnancy, and the occurrence of GDM, GHT, and preeclampsia was recorded. GDM was diagnosed using a 75-g oral glucose tolerance test according to International Association of Diabetes and Pregnancy Study Groups criteria. Statistical analyses were performed using appropriate parametric and non-parametric tests. Results: Pregnancy-related complications developed in 41 (24.1%) participants, including GDM in 19 (11.2%), GHT in 28 (16.5%), and preeclampsia in 4 (2.4%) cases. ABSI values did not differ significantly between women with and without pregnancy complications (p=0.437). In contrast, BMI and waist circumference were significantly higher in women who developed complications (p=0.006 and p=0.010, respectively). Among specific outcomes, BMI and waist circumference were significantly associated with GHT, whereas ABSI showed no significant association. Conclusion: Early pregnancy ABSI was not associated with the development of GDM, GHT, or preeclampsia. Conventional anthropometric measurements, particularly BMI and waist circumference, appeared more informative for identifying women at risk of pregnancy-related complications. Larger prospective studies are needed to confirm these findings.
Objective: We aim to identify female reproductive system cancers' neoepitopes that can be used to develop personalized cancer vaccines with multi-patient applicability based on shared sequences among other cancer neoepitopes. Material and Methods: Immune Epitope Database (IEDB)-deposited cancer neoepitopes were inspected for shared pentapeptide sequences within linear neoepitopes, based on user-defined cutoffs, and were used to identify compatible human leukocyte antigen (HLA)-types. Shared pentapeptide sequences binding to the same HLA alleles were further selected and screened against the sequences of epitopes linked to autoimmune diseases deposited at IEDB to identify any potential for initiating a similar autoimmune response through cross-reaction. To support the possibility of cross-reactivity, the identified autoimmune disease-associated epitopes were back-predicted for their binding affinities to the same alleles as those of the neoepitopes of interest. Results: Gapless sequence alignment-based clustering of neoepitopes revealed that the group with the highest number of neoepitopes involved three female reproductive system cancer neoepitopes; two endometrial and one ovarian. Two other groups contained ovarian cancer-related neoepitopes. RAS-derived neoepitopes had the widest coverage among all identified shared neoepitopes across multiple cancer types, including endometrial cancer, and highest variation of HLA-alleles. HLA-alleles binding to endometrial and ovarian cancer neoepitopes were among the most prevalent alleles. Patients with neoepitopes from endometrial and ovarian cancers, who are also HLA-A*11:01 and HLA-B*07:02 carriers, respectively, may benefit from vaccines targeting the same sequence-sharing neoepitopes, with follow-up suggested for autoimmune response. Conclusion: Results suggest broader applicability of personalized cancer vaccines in patients having identical tumor-specific mutations and compatible HLA-types, including those with ovarian and endometrial cancer.
Objective: We sought to investigate the role of androgen excess and oligoovulation or anovulation, two major diagnostic criteria of polycystic ovary syndrome (PCOS), and their effect on hemoglobin concentrations. Material and Methods: This prospective, crosssectional study included 82 PCOS (based on Rotterdam's criteria) and 69 non-PCOS women aged 20-25 years who attended our obstetrics and gynecology outpatient clinic between January and June 2016. All participants underwent a medical history, physical examination, hematologic assessment, and biochemical tests. PCOS patients were compared with non-PCOS controls in terms of hemoglobin levels and the prevalence of anemia. Results: No differences in age, socioeconomic status, or education level were identified between the groups. Mean hemoglobin concentrations in the PCOS and control groups were 13.2 +/- 0.9 (9.4-15.1) and 12.8 +/- 1.0 (9.6-14.8) g/dL, respectively. The prevalence of anemia was lower among patients with PCOS (8.5%) compared with controls (17%), with mean hemoglobin concentrations significantly higher in patients with PCOS (p=0.015). Conclusion: Oligoovulation or anovulation and androgen excess, 2 major diagnostic criteria of PCOS, may affect hemoglobin concentrations. The data presented here show that women with PCOS had significantly higher levels of hemoglobin and lower rates of anemia compared with healthy controls.
Objective: To assess whether the first-trimester Leukoglycemic Index (LGI) predicts the later development of gestational diabetes mellitus (GDM) and what its diagnostic performance is, as well as the incremental predictive value beyond conventional clinical risk factors. Material and Methods: This single-center retrospective cohort study included 986 pregnant women who had first-trimester leukocyte count and fasting plasma glucose values available, with documented 75-g oral glucose tolerance test results at 24-28 weeks. LGI was calculated by multiplying leukocyte count by fasting plasma glucose. Diagnostic performance was assessed by receiver operating characteristic analysis and area under the curve (AUC) for independent predictors identified through multivariable logistic regression. Model improvement will be assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI), while clinical usefulness can be determined through decision curve analysis. Results: GDM was developed in 24.9% of participants. LGI was significantly higher in women who developed GDM (p<0.001) and remained an independent predictor together with age and body mass index. LGI has a good discriminatory ability (AUC=0.74), outperforming fasting glucose and leukocyte count. Adding LGI to the clinical model increased the AUC from 0.73 to 0.81 with meaningful reclassification gains (NRI=0.17; IDI=0.04). Conclusion: First-trimester LGI is a simple index reflecting both inflammatory burden and glycemic load that significantly improves early GDM prediction when added to routine clinical models; hence, supporting it as a promising adjunct biomarker but requiring prospective multicenter validation for wide implementation.
Objective: To improve the prognosis of cervical cancer, it is of significant clinical importance to further investigate the novel mechanisms underlying the occurrence and search for precise prognostic markers and effective therapeutic targets. Material and Methods: Transcriptome data and clinical information of patients with cellular components (CC) were downloaded from the Cancer Genome Atlas database. Differentially expressed genes (DEGs) associated with cellular pyrolysis were identified, clustered, and typed, and different types of DEGs were obtained. A prognostic model was constructed, and functional enrichment analysis of these DEGs was performed. The singlesample gene set enrichment analysis algorithm was adopted to investigate the relationship between the risk scores and the tumor immune microenvironment. Drug susceptibility prediction and molecular docking were performed based on the obtained core genes. Results: We established a CC prognostic model encompassing 24 characteristic DEGs. The risk score is associated with poor CC outcomes and lower survival rates for the high-risk group compared to the low-risk group. We found significant differences in immune infiltration and drug sensitivity analyses between the high-risk and low-risk groups (p<0.05). Conclusion: The prognostic model constructed based on 24 characteristic DEGs may possess significant biological functions in cervical cancer and offer a novel perspective for the prognosis of cervical cancer.
ABS TRACT Objective: Timing of delivery is vital for a healthy pregnancy outcome. An increase in morbidity and mortality exists on both extremes of gestation, preterm and postterm. This study's objective was to compare the elective induction of labor at 39 weeks gestational age among low-risk nulliparous women with singleton pregnancies to expectant management. Material and Methods: It was a randomized control study over 1 year. Low-risk nulliparous, singleton live pregnancy with a cephalic presentation at >38 weeks were included. Women not consenting, high-risk pregnancy, contraindications to vaginal delivery, and unreliable dates were excluded. Women were randomized into Group A-low-risk nulliparous, singleton live pregnancy with cephalic presentation induced at 39 to 39+ 3 weeks. Group B-low-risk nulliparous expectantly followed and induced after 41 weeks. Results: A total of 300 women were included in the study, 147 were included in Group A and 153 in Group B. Cesarean section rate was similar with 25.2% in group A compared to 24.8% in group B. Neonatal morbidity increased in group B (27.5%) compared to group A (15.6)% with p value of <0.013. Conclusion: Elective induction at 39 weeks of gestation did not increase cesarean rates & had better neonatal outcomes than the expectant group. Elective labor induction should be a shared decision-making process with informed consent.
Objective: Previous cesarean delivery is a major indication for repeat cesarean section. However, a substantial proportion of women enter spontaneous labor before the planned date, increasing maternal and neonatal risks. This study aimed to assess whether selected transvaginal ultrasonographic markers can predict early labor in women scheduled for elective cesarean delivery. Material and Methods: In this prospective cohort study, 102 women with prior cesarean delivery were scheduled for elective cesarean at 38-39 weeks. Cervical length, anterior uterocervical angle (UCA), and lower uterine segment thickness (LUT) were measured by transvaginal ultrasonography after 34-35 weeks. Women who entered spontaneous labor and required urgent cesarean delivery before the scheduled date were compared with those who delivered as planned. Results: Twenty -six women (25.5%) required urgent cesarean delivery. The urgent delivery group had significantly thinner LUT (4.7 +/- 1.4 mm vs. 8.6 +/- 2.4 mm, p<0.01) and wider UCA (105 degrees vs. 95 degrees, p<0.01). Cervical length did not significantly differ between the groups. Logistic regression identified LUT as the strongest independent predictor of early labor (odds ratio 0.392, 95% confidence interval 0.256-0.604, p<0.01). Receiver operating characteristic analysis showed that a LUT cut-off value of <6.5 mm predicted early labor with 88.5% sensitivity and 76.7% specificity (area under the curve 0.908). Conclusion: About one-fourth of women scheduled for elective cesarean delivery may enter labor before the planned date. Thinner LUT and wider UCA provide meaningful predictive information for identifying women at risk of early labor. Incorporating these sonographic markers into preoperative assessment may support individualized cesarean timing and help reduce unplanned procedures.
Objective: To compare antenatal depression (AD) symptoms between Syrian immigrant and Turkish pregnant women and to identify sociodemographic and obstetric factors associated with AD. Material and Methods: This cross-sectional study was conducted between September 15 and December 30, 2019, at & Uuml;mraniye Training and Research Hospital, a tertiary public hospital in T & uuml;rkiye. A total of 603 pregnant women (402 Turkish and 201 Syrian) were assessed during routine antenatal follow-ups. Data were collected through face-toface interviews using a sociodemographic questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), and the Beck Depression Inventory (BDI), with the assistance of hospital interpreters. Results: Antenatal depressive symptoms were significantly more prevalent among Syrian immigrant women compared with Turkish women based on both screening tools (BDI >= 17: 30.8% vs. 15.4%, chi & sup2;=18.7, p<0.001; EPDS >= 13: 33.8% vs. 25.6%, chi & sup2;=4.4, p=0.035). Mean depression scores were also higher among Syrian women (BDI: 12.62 +/- 7.09 vs. 9.67 +/- 7.29, p<0.001; EPDS: 9.58 +/- 5.53 vs. 8.53 +/- 5.93, p=0.014). Ower educational attainment low socioeconomic status unplanned pregnancy, inadequate social support, impaired interpersonal relationships, and psychiatric history were significantly associated with elevated depressive symptom scores in both groups (p<0.05). Obstetric variables such as gravidity and trimester were not independently associated with AD. Conclusion: Approximately 1 in 3 Syrian immigrant women and 1 in 5 Turkish women were screened positive for AD. Immigrant status, together with socioeconomic and psychosocial vulnerability, represents a major risk factor for AD. Routine screening, early identification of psychosocial risk factors, and multidisciplinary care are essential to reduce adverse maternal and neonatal outcomes.
Objective: This study investigated the associations of menstrual history, cycle characteristics, and premenstrual syndrome (PMS) with body image disturbance and body image flexibility in female university students. Material and Methods: In this cross-sectional study, undergraduate students completed an online survey including questions on menstrual history and cycle characteristics, the Premenstrual Syndrome Scale, the Body Image Disturbance Questionnaire (BIDQ), and the Body Image-Acceptance and Action Questionnaire (BI-AAQ). Group comparisons, correlation analyses, and regression models were performed. Results: A total of 518 female students participated (mean age 21.34 +/- 2.19 years). Age at menarche was positively correlated with BI-AAQ scores (r=0.121, p=0.006), suggesting greater body image flexibility with later menarche, but was not associated with BIDQ scores. PMS was present in 317 participants (61%) and was associated with earlier menarche (p<0.001) and longer menstrual bleeding duration (p=0.045). Participants with PMS had significantly higher BIDQ scores (p<0.001, d=0.549) and lower BI-AAQ scores (p<0.001, d=0.718). However, correlations between PMS subscales and body image measures were weak, and regression analyses did not identify significant predictors. Supplementary analyses showed higher BIDQ scores in overweight and obese participants and higher BI-AAQ scores in underweight participants. Conclusion: Later menarche was associated with greater body image flexibility, whereas PMS was associated with greater disturbance and lower flexibility. Overall, these associations were modest and likely multifactorial.
ABS TRACT Objective: To evaluate gynecological emergencies in patients using warfarin and to discuss optimal management strategies. Material and Methods: This retrospective descriptive study included 20 patients receiving warfarin therapy with an international normalized ratio (INR) >= 2 who presented with gynecologic emergencies at a tertiary center between January 2017 and May 2023. Demographic data, indications for warfarin use, laboratory findings, interventions, transfusions, surgical procedures, length of hospital stay, and clinical outcomes were analyzed. Results: Patients were classified into 2 groups. Group 1 (n=10) included intra-abdominal hemorrhage cases, including ovarian cyst rupture, corpus luteum rupture, and postoperative bleeding. Group 2 (n=10) comprised patients with abnormal uterine bleeding (AUB). In Group 1, the mean age was 38.1 +/- 8.29 years, hemoglobin 6.69 +/- 1.36 g/dL, and INR 4.73 +/- 2.00. Conservative treatment was successful in 3 patients, whereas seven required surgery. In Group 2, the mean age was 39.8 +/- 9.67 years, hemoglobin 7.15 +/- 1.43 g/dL, and INR 3.42 +/- 1.84. Two patients underwent hysteroscopic procedures, and one required hysterectomy. Levonorgestrel-releasing intrauterine devices (LNG-IUD) were placed in seven patients. Conclusion: In this retrospective descriptive study, conservative management was often sufficient in hemodynamically stable patients, whereas surgery was required for uncontrolled bleeding. LNG-IUD were frequently used for AUB; however, the overall findings should be interpreted cautiously given the retrospective design, limited sample size, and absence of comparative analyses. Management of gynecological emergencies in patients receiving warfarin may benefit from an individualized, multidisciplinary approach.
Objective: Non-opioid analgesia can be used in post-cesarean section (CS); transversus abdominis plane (TAP) block is the recent and widely investigated one with controversy about its efficacy in reducing post-CS pain and amount of opioid analgesia needed. To study the TAP block efficacy in postoperative analgesia and identify the satisfaction of patients with it. Material and Methods: A comparative prospective study was performed from November 2017 to November 2019. One hundred women underwent CS, 50 of which had general anesthesia followed by TAP block (the TAP group), versus 50 who underwent just general anesthesia (no TAP group). Monitoring of pain was scheduled at 1, 2, 4, 6, 12, and 24 hours by visual analog scale (VAS). The first time to require analgesia and overall analgesic dose in 24 hours was documented. After 24 hours, patient satisfaction with the relief of postoperative pain was documented. Results: Compared with the no TAP group, the TAP group exhibited significantly lower VAS from 1 hour up to 24 hours (p from <0.001 to 0.04) with a significantly higher mean time to first rescue analgesia (2.3 +/- 1.11), (10.5 +/- 6.43 hours), (p<0.001), and a significantly lower total tramadol need (179 +/- 25.54 mg), (51 +/- 26.46 mg), (p<0.001). Eight women demanded first rescue analgesia before the first 6 hours versus 48 in the no TAP group, and the patients' satisfaction score was higher. Conclusion: Postoperative analgesia by TAP block is effective and lowers postoperative rescue analgesic.
Objective: Chronic endometritis (CE) diagnosis and popularity are increasing. Although the hysteroscopic and pathological diagnostic criteria of this chronic inflammatory disease have been determined, it is observed that hysteroscopic findings sometimes do not match with the pathological results. We planned to investigate whether complete blood count (CBC) parameters, which are a cheaper technique in addition to the existing criteria, are useful in the diagnosis of CE. Material and Methods: A 7-year hysteroscopy data from a single center was scanned. Seventy four patients with CE observed in hysteroscopy were included in the study. These patients were divided into 2 groups according to whether CE was present in the pathology results. Preoperative CBC parameters were compared between these 2 groups. Results: The groups had no significant differences regarding hemoglobin, hematocrit, white blood count, platelets, neutrophils, lymphocytes, monocytes, mean platelet volume, and platelet-to-lymphocyte. However, the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet distribution width were significantly higher in the CE group. Conclusion: Although it is not possible to see it as a definitive diagnostic method, the CBC examination, which is performed in almost every patient, combined with hysteroscopic findings in CE will be beneficial in the diagnosis of CE. CBC is both a cost-effective and effective method in supporting this diagnosis.
Objective: This study aimed to investigate the effects of L-citrulline on oxidative stress and histopathological damage in ovarian ischemia-reperfusion (I/R) injury in rats. Material and Methods: The rats were divided into 3 groups. Group 1 served as the control group; Group 2 consisted of rats that underwent ischemia followed by reperfusion. In Group 3, L-citrulline was delivered 30 minutes before I/R. The ovary and uterine were excised for histopathological and biochemical analysis. The total thiol (TT), native thiol (NT), disulfide (SS), and the percentage of disulfide to reactive thiol (SS/-SH) were measured from blood to assess the antioxidant capacity of L-citrulline. Hematoxylin and eosin staining was used for histopathological scoring of ischemic damage in the ovaries. Results: TT levels exhibited no significant differences among the groups; NT values were comparable in the sham and I/R+L-Citrulline groups, although significantly reduced in the I/R group relative to the other groups. The SS and SS/SH levels were markedly reduced in the sham group compared to the other groups. Estradiol concentrations were markedly elevated in the sham group compared to the ischemic group. The evaluation of the post-ischemia groups in terms of oxidative stress demonstrated no significant differences in TT, NT, SS, SS/-SH, and estradiol levels between the I/R group and the L-citrulline therapy group. Histopathological examination showed that follicular degeneration, cellular vacuolization, intercellular edema, vascular congestion and hemorrhage were significantly reduced in the L-citrulline group compared with the ischemia group, but inflammation was not. Conclusion: Administering L-citrulline reduces histopathological damage in the ovarian tissue but does not reduce oxidative stress radicals.
Objective: Preeclampsia is the major contributor of maternal morbidity and maternal mortality in developing countries. Many predictor tests have been identified for preeclampsia. To assess lipid profile in 2nd trimester of pregnancy and analyze it as a predictor of preeclampsia. Material and Methods: The prospective observational study was conducted at L.N. Medical College and Research Center&J.K. Hospital, Bhopal, involved 144 pregnant women aged 18-35 years in their 2nd trimester (14-20 weeks gestation) and lipid profile was measured at this gestation. Women were followed up until delivery and observed whether preeclampsia developed (study group) or not (control group). Serum lipid levels in the 2 groups were compared. The data were analyzed statistically and dyslipidemia as a predictor of preeclampsia was studied. Results: Mean low-density lipoprotein (LDL), mean cholesterol and mean triglyceride values were significantly increased in the study group compared to the control group 132 +/- 31.61 mg/dL v/s 103.10 +/- 26.63 mg/dL (p<0.0001) and 226.5 +/- 37.72 mg/dL v/s 176.14 +/- 40.93 mg/dL (p<0.0001) and 217.45 +/- 45.55 mg/dL v/s 147.69 +/- 43.55 mg/dL (p<0.0001) respectively. The mean high-density lipoprotein (HDL) was significantly low in the study group 40 +/- 8.99 mg/dL in comparison to the control group 55.11 +/- 10.01 mg/dL (p<0.0001). There was no significant difference in the mean very low density lipoprotein levels 11.17 +/- 3.09 mg/dL v/s 10.22 +/- 2.45 mg/dL (p=0.116). Conclusion: Second trimester LDL, triglycerides, and cholesterol were significantly increased and HDL was significantly lower in women who developed preeclampsia later in gestation. Therefore, we can take altered values of lipid profile in 2nd trimester as a predictor of preeclampsia.
Objective: To evaluate the effects of intraoperative tranexamic acid (TXA) administration on perioperative bleeding, blood transfusion need, operation duration, and hospital stay in patients undergoing myomectomy. Material and Methods: This case-control study included 56 patients who underwent laparotomic myomectomy between March 2023 and January 2024. Twenty-eight patients received TXA intraoperatively, and 28 served as controls. Demographic characteristics, platelet count, coagulation parameters, fibroid characteristics, erythrocyte suspension (ES) transfusion need, and pre- and postoperative hemoglobin values were compared. ES transfusion was indicated for patients with a shock index >1. Results: No statistically significant differences were found between groups regarding demographics, platelet count, coagulation parameters, or fibroid features (p>0.05). Postoperative 2(nd) and 6(th) hour hemoglobin and hematocrit values were not significantly different between the groups (p>0.05). However, the ES transfusion rate was significantly lower in the TXA group than in the control group (p=0.049). Conclusion: Intraoperative TXA administration effectively reduced the need for ES transfusion, suggesting beneficial effects on bleeding control. However, its antifibrinolytic impact appeared limited due to the overall low amount of bleeding. In cases without transfusion, no significant differences in hemoglobin or hematocrit levels were detected, indicating that the limited fibrin formation in lowbleeding conditions may have restricted TXA efficacy.
Objective: This study aimed to investigate the effect of childbirth education classes on maternal-fetal outcomes and the mode of delivery. Material and Methods: Patients followed during pregnancy at the Antenatal Clinic of the Maternity Unit of Ankara Bilkent City Hospital were included in the study. The study group consisted of women who completed childbirth education classes, while the control group included women who did not receive such education. Results: A total of 216 patients participated, with 108 in the study group and 108 in the control group. The mean age was 27.18 +/- 4.23 years. Parity analysis revealed that 71.8% (n=155) were primigravidas and 28.2% (n=61) were multiparous. Regarding delivery mode, 77.8% (n=168) had vaginal deliveries, and 22.2% (n=48) had cesarean sections. The mean gestational age at delivery was 39.40 +/- 1.03 weeks, and the average neonatal birth weight was 3,320.04 +/- 387.75 grams. No statistically significant differences were observed between the groups in terms of maternal age, parity, gestational age, mode of delivery, 1-min APGAR score, neonatal weight, duration of labor, induction of labor rates, complications, or hemoglobin levels before and after delivery (p>0.05). Conclusion: The childbirth education classes did not significantly reduce the operative birth rates and improve maternal-fetal outcomes. However, the retrospective nature of the study and patient selection criteria limit the establishment of a definitive causal relationship between childbirth education classes and the route of birth.
ABS TRACT Objective: This study aimed to investigate the expression of HER2/neu, MUC1, and estrogen and progesterone receptors in malignant epithelial ovarian cancer (EOC) and determine their effects on clinical-pathological features and prognosis. Material and Methods: The study included 86 patients diagnosed with EOC. The histopathological types were high-grade serous carcinoma (HGSOC; n=46 patients), lowgrade serous carcinoma (LGSOC; n=7 patients), mucinous carcinoma (MC; n=14 patients), and clear cell carcinoma (CCC; n=19 patients). The patients" demographic, clinical-pathological, and prognostic characteristics were reviewed retrospectively. The pathological separates of the patients were immunohistochemically applied with MUC1, HER2/neu, estrogen, and progesterone antibodies, and the expression status of these markers was analyzed for their relationship with clinical-pathological features and prognosis using statistical methods. Results: MUC1 was strongly positive in LGSC and CCC patients, with a lower frequency in MC and higher in HGSC (p<0.001). In 50% of MC cases, HER2/neu staining was strongly positive. In addition, 85.7% of LGSC cases had positive estrogen receptor (ER) (p=0.041) and progesterone receptor (PR) (p=0.029). All 16 patients in the HGSC group, who were resistant to platinum therapy, tested positive for ER staining. Additionally, 93.7% of these patients were highly positive for MUC1 staining. Conclusion: The study found that MUC1 was highly positively stained in the LGSC and CCC groups, platinum-resistant patients had high estrogen-PR expressions, and half of the MC group tested positive for HER2/neu. These results are important for targeted therapy in difficult-to-manage EOC.
ABS TRACT Objective: The transversus abdominis plane (TAP) block, particularly when performed under ultrasound guidance, has shown promise in providing regional anesthesia and reducing postoperative pain. This study aimed to evaluate the effectiveness of ultrasound-guided TAP block for postoperative pain relief in women undergoing Cesarean section in a prospective, randomized, double-blind, placebo-controlled trial. Material and Methods: A total of 312 women undergoing primary Cesarean section were randomized to receive either an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine or a placebo (20 mL of normal saline) following the surgery. Results: Among the 312 patients, 157 and 155 were allocated to the TAP and placebo groups, respectively. Visual analogue scale (VAS) analysis for pain scoring was performed postoperatively. In the TAP group, 2%, 6%, 6.6%, 9.9%, 11.9%, and 4.7% patients had VAS scores >4 at 4, 8, 12, 16, 20, and 24 h, respectively, compared with 8.8%, 79.8%, 14.8%, 69.1%, 11.5%, and 53.6% in the placebo group (p<0.05 for all). The mean time to first analgesia was significantly longer in the TAP group (10.9 +/- 2.1 hours) versus placebo (6.8 +/- 1.9 hours). The total 24-h analgesic consumption was also significantly lower in the TAP group (p<0.05). Nausea and pruritus were more common in the placebo group (12.1% vs. 4% and 8.1% vs. 1.3%, respectively). Conclusion: USG-guided TAP block significantly improves postoperative pain control and reduces both non-steroidal anti-inflammatory drugs and opioid consumption in patients undergoing Cesarean section.
Objective: Fetal health classification is of great clinical importance as it allows the early detection and management of fetal health problems during pregnancy.This study aims to enhance fetal health classification by integrating Light Gradient Boosting Machine (LightGBM), synthetic minority oversampling technique (SMOTE), and Optuna-based hyperparameter tuning. The goal is to improve classification accuracy, address class imbalance, and optimize model performance in predicting normal, suspicious, and pathological fetal health conditions. Material and Methods: The study utilized the University of California, Irvine "Cardiotocography Data Set" which contains 2.126 fetal cardiotocography (CTG) records classified into 3 categories. To handle class imbalance, SMOTE is applied. Various machine learning models [Stochastic Gradient Descent Classifier, Gradient Boosting, Decision Tree, Support Vector Machine, K-Nearest Neighbors, and Logistic Regression (LG)] were compared, with LightGBM selected due to its efficiency in structured medical data processing. Optuna is used for hyperparameter tuning. The dataset was split into 80% training and 20% testing, and model performance was assessed using accuracy, precision, recall, and F1-score. Results: The optimized LightGBM+SMOTE+Optuna model achieved 99% accuracy, significantly outperforming the other classifiers. The recall and F1-score for the suspicious and pathological classes improved, reducing the misclassification rates. The confusion matrix confirmed a substantial decrease in errors, demonstrating the model's robustness and reliability. Conclusion: The proposed model successfully enhances fetal health classification accuracy by addressing class imbalance and optimizing hyperparameters. The integration of LightGBM, SMOTE, and Optuna improves model generalization, making it a valuable tool for fetal health assessment. Future studies could explore deep learning approaches to further refine classification performance and support clinical decision-making.
Objective: This prospective study aimed to explore sexual dysfunction during pregnancy by comparing sexual function and depression scores among high-risk pregnant women, healthy pregnant women, and healthy non-pregnant women of reproductive age. Material and Methods: Data were collected from 553 participants who provided complete responses using the sociodemographic and pregnancy history forms, the Female Sexual Function Index, and the Beck Depression Index. Results: Pregnant women, compared to non-pregnant individuals, exhibited significantly lower scores in desire, arousal, lubrication, orgasm, satisfaction, pain parameters, and total sexual function (p<0.001 for all parameters), with a significantly higher total Beck Depression score (p=0.022). High-risk pregnancies showed even lower scores in desire, arousal, lubrication, orgasm, satisfaction, pain parameters, and total sexual function (p<0.001 for all parameters), with a significantly higher total Beck Depression score (p=0.003) compared with healthy pregnant participants. Among the 3 groups, high-risk pregnant women had the highest prevalence of sexual dysfunction (p<0.001) and depression symptoms in the Beck Depression scores (p=0.001). The 3rd trimester was identified as the most vulnerable period for sexual dysfunction (p<0.001), while depression symptoms were most common in the 1st trimester (p<0.001). Conclusion: Pregnancy significantly increases the risk of sexual dysfunction and depression. Concurrent conditions such as hypertension, diabetes, and thyroid dysfunction intensify these challenges during pregnancy. Recognizing and addressing these factors are crucial to improving the overall well-being and quality of life of pregnant women.
